Tan-Shen and Midazolam Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Midazolam Injection
Tan-Shen
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased risk of central nervous system depression
Interaction Deep Dive
Miltirone and the other nine diterpene quinones present in Salvia miltiorrhiza (Tan-shen) appear to act as partial agonists at central benzodiazepine receptors1. While this is likely responsible for anxiolytic activity of tan-shen, it appears that sedation, muscle relaxation, and addiction qualities are minimized 1. Because tan-shen acts as a partial and not a full agonist, the clinical significance of the interaction is unknown. Caution is advised until the magnitude of the interaction is better understood.
Why it happens (mechanism)
Partial agonist activity at central benzodiazepine receptors
Literature reports
1 report — tap to read
a) Ten diterpene quinones present in the Chinese medicinal herb Salvia miltiorrhiza (tan-shen) have been shown to inhibit binding of (3H) flunitrazepam to central benzodiazepine receptors. These quinones, isolated from the ethereal extract of the roots of Salvia miltiorrhiza, exhibited IC50s ranging from 0.3 to 36.2 mcmol (the IC50 is the drug concentration required to provide 50% inhibition of specific (3H) flunitrazepam binding). Miltirone had the highest potency (IC50=0.3 mcmol) 1. Oral administration of miltirone (10-60 mg/kg) increased the number of punished crossings of mice in the Four-Plate Test which is an indication of clinical tranquilizing effects. The magnitude of this effect was lower than that observed with diazepam 1.
Common questions
Can I take Tan-Shen and Midazolam Injection together?
Increased risk of central nervous system depression Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tan-Shen and Midazolam Injection interaction?
It is rated minor. Usually limited clinical impact.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Tan-Shen or Midazolam Injection need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Lee CM, Wong HCN, Chui KY, et al: Miltirone, a central benzodiazepine receptor partial agonist from a Chinese medicinal herb Salvia miltiorrhiza. Neurosci Lett 1991; 127:237-41. PubMed
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